Breast reconstruction is a surgical procedure performed for women who
had mastectomy. Mastectomy is surgical procedure that removes the
entire breast and surrounding tissues to prevent
breast cancers.

The surgery is performed to rebuild the lost breast so that it matches
the symmetry of the opposite breast. The surgery may involve implant
reconstruction, your own tissues (tissue flap), or a combination of the
two. After the breast tissue is reconstructed, later surgery may be
required to reconstruct the nipple and the areola, dark area surrounding
the nipple.

Breast is an important feature of a woman’s
physical characteristics that symbolizes a woman’s femininity. Women
who lost their breast after mastectomy consider breast reconstruction
because they want to feel feminine again by having their breast restore.
The scar from mastectomy can be a constant reminder of breast cancer
and by having the breast restore allow women to move on to lead a normal
lives before mastectomy.

Implant Reconstruction Procedures

There are two types of
breast implants, saline-filled implants and silicone-gel-filled implants. Saline-filled
implant is a silicone pouch filled with saline liquid which is most
commonly used. Silicone-gel-filled implant is a silicone pouch filled
with silicone. There are two types of implant reconstruction procedures
and these include one-stage immediate reconstruction and two-stage
reconstruction (immediate or delayed).

One –stage immediate
reconstruction is performed at the time of mastectomy. Surgical
procedure to remove the breast tissues is performed by the surgeon, once
the breast tissues is removed breast implant is performed by plastic
surgeon to rebuild the lost breast. The benefit from one-stage
immediate reconstruction allows women to recover from both surgeries at
the same time.

Two-stage reconstruction can be immediate or
delayed. Two-stage immediate reconstruction can be performed if
radiation therapy is not required after mastectomy. Breast
reconstruction is delayed if radiation therapy is required after
mastectomy. Radiation therapy given after when the breast has been
reconstructed can cause many problems.

Two-stage reconstruction
is performed when the chest area is flat with insufficient loose skin.
The process involves the use of tissue expander, a balloon shape device
that is place under the chest muscle. The tissue expander is injected
with saline liquid causing it to expand, and the skin over the tissue
expander stretches overtime to form breast contour. The procedure takes
several months to stretch the skin and once the skin has been stretched
enough, a second surgery is performed to remove the expander and the
implant is put in place.

Breast Reconstruction Using Your Own Tissues

Implant
reconstruction is not ideal for everyone because some patients who are
left with very thin skin and lost major muscle in the chest area after
mastectomy may not be a good candidate. When a patient lost excess
tissues in the chest area, tissue expansion become impossible with the
use of tissue expander.

The alternate option of breast reconstruction
is using the patient’s own tissues also known as tissue flap surgery.
This type of procedure involves surgically removing tissues from one
part of the body and moving it to the chest area. The tissues may be
taken from the abdomen, upper back, or buttocks to reconstruct the
breast. Individual who have diabetes and smokers are not a good
candidate for tissue flap surgery.

There are two types of
tissue flap surgery and these include TRAM (transverse rectus abdominis
muscle) flap and latissimus dorsi flap. TRAM flap procedure remove
tissues from the abdomen and latissimus dorsi flap procedure remove
tissues from the upper back.

TRAM Flap Procedures

TRAM
flap procedures involve removing a portion of skin, fat, and muscle from
the abdomen and transferred to chest area to form a new breast. This
operation leaves 2 scars on surgical site, one on the abdomen where the
tissues is removed and one on the chest area where the new breast is
reconstructed. TRAM procedures can reduce strength in the abdomen and
is not ideal for individual who had “tummy tuck” from previous surgery.
There are two types of TRAM flap procedures, the pedicle flap and free
flap.

• In pedicle flap, the flap remains attached to its blood
supply and reconstructed on the chest area by tunneling it under the
skin.

• In free flap, the flap is detached from its original
blood supply and reattached to the blood vessels in the chest area.
This procedure takes longer than pedicle flap because it requires the
use of microsurgery to connect the flap to the blood vessels in the
chest area.

Latissimus Dorsi Flap Procedures

Latissimus
flap procedure involves removing a portion of skin, fat, and muscle from
the upper back and tunnel to the chest area to form a new breast. This
procedure may be used in combination with implants. Latissimus flap
alone can provide enough bulk for women with smaller breast size. For
women with larger breast size, Latissimus flap is used in combination
with implants to provide the extra bulk. This operation leaves 2 scars
on surgical site, one on the upper back where the tissues is removed and
one on the chest area where the new breast is reconstructed.

Gluteal Flap Procedures

Gluteal
flap procedure involves removing a portion of skin, fat, and muscle
from the buttocks and transferred to the chest area to form a new
breast. This is a free flap procedure with longer operating time and
requires the use of microsurgery to connect the flap to the blood
vessels in the chest area. This is an alternate breast reconstruction
option for women that do not prefer the TRAM flap or latissimus flap
procedures.

Nipple Reconstruction

Nipple and areola
reconstruction is performed after when breast reconstruction is
completed. Nipple reconstruction can be performed with flap
reconstruction or graft reconstruction. Flap reconstruction is
procedure in which skin and fat tissues surrounding the new nipple is
removed to construct new nipple. Flap reconstruction can leave scars on
the breast surrounding the new nipple.

Graft reconstruction is
procedure in which nipple grafts is harvested from the opposite nipple,
the labia, and the earlobe. The new nipple is reconstructed from
harvested nipple grafts. Graft reconstruction can leave scars on the
breast surrounding the new nipple. The site from where the nipple
grafts is harvested can also leave behind scars.

Areola Reconstruction

Areola
reconstruction is performed after the new nipple has been
reconstructed. Areola can be reconstructed by tattooing or graft
reconstruction. Tattooing is a general process used to create areola
with color matching the opposite breast. Graft reconstruction involves
harvesting skin from inner thigh and inner gluteal area which is used to
reconstruct new areola. Some patients that are going through breast
reduction, the extra portion of the areola that is been removed can be
used to reconstruct new areola for the new breast.